Provider Demographics
NPI:1760291306
Name:CASTILLO, GENNAN
Entity type:Individual
Prefix:
First Name:GENNAN
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10041 SW 38TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3939
Mailing Address - Country:US
Mailing Address - Phone:786-322-9641
Mailing Address - Fax:
Practice Address - Street 1:10240 SW 56TH ST UNIT 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7071
Practice Address - Country:US
Practice Address - Phone:786-322-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care